Jeremy Richard Katz MD, Presenter: Nothing to Disclose

Ron Charles Gaba MD, Abstract Co-Author: Nothing to Disclose

Steven Reich BS, Abstract Co-Author: Nothing to Disclose

Benedictta Onoweneri Omene MD, Abstract Co-Author: Nothing to Disclose

Martha-Gracia Knuttinen MD, PhD, Abstract Co-Author: Nothing to Disclose

James Thuan Bui MD, Abstract Co-Author: Nothing to Disclose

Charles A. Owens MD, Abstract Co-Author: Nothing to Disclose

To determine the safety, efficacy, and clinical outcomes following splenic artery embolization.

In this retrospective study, 46 patients (M:F=31:15, mean age 48 years) underwent 46 splenic artery embolizations from 1998-2010. Procedure indications included aneurysm or pseudoaneurysm (n=15, 33%), gastric variceal hemorrhage (n=11, 24%), pre-operative (n=8, 17%), or other (n=12, 26%). 19/46 (41%) procedures were elective, and 27/46 (59%) were urgent or emergent. Embolic agents consisted of combinations of coils (n=46), gelfoam (n=14), and particles (n=5). Measured outcomes were procedure technical success, adverse side effects, efficacy, and 30-day morbidity and mortality rates.

All embolizations were technically successful. Adverse side effects included pleural effusion (n=28, 64%), reactive thrombocytosis (n=15, 33%), thrombocytopenia (n=12, 27%), and post-embolization syndrome (n=10, 22%). 13/46 (28%) patients suffered partial or complete splenic infarction. Minor technical complications included groin hematoma (n=2, 7%) and coil migration (n=1, 2%). Procedure efficacy was 87%; 6/46 (13%) patients had recurrent hemorrhage requiring repeat embolization or surgery. Major 30-day morbidity occurred in 17/46 (37%) patients, and included infection (12/46, 26%), splenoportal thrombosis (4/46, 9%), splenic abscess (1/46, 2%), femoral hematoma requiring surgery (1/46, 2%), and pulmonary embolism (1/46, 2%). 30-day overall mortality rate was 9% (4/46). Advanced patient age (54 vs. 44 years, P=0.09), post-procedure thrombocytopenia (113 vs. 201 1000/μL, P=0.007), and presence of post-procedure pleural effusion (81% vs. 44%, P=0.01) were risk factors for complications on univariate analysis. Elevated creatinine (2.2 vs. 0.9 mg/dL, P<0.001), post-procedure thrombocytopenia (60 vs. 201 1000/μL, P=0.007), and pre-procedure leukocytosis (21.4 vs. 8.9 1000/μL, P=0.007) were risk factors for mortality on univariate analysis.

Splenic artery embolization was performed with high technical success and efficacy in this series, but was associated with non-trivial morbidity and mortality rates. Thrombocytopenia, renal insufficiency, and leukocytosis were risk factors for mortality.

Splenic artery embolization may be performed with high technical success and efficacy, but patients require close post-procedure monitoring for adverse effects.

Katz, J, Gaba, R, Reich, S, Omene, B, Knuttinen, M, Bui, J, Owens, C, Splenic Artery Embolization: Safety, Efficacy, and Clinical Outcomes in 46 Procedures Performed over 12 Years.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11000145.html